Back in the Headlines: Niger

I spent a year living in Niger from mid-2005, courtesy of a media-labelled ‘famine’ that put about a third of the county’s population at risk of acute food shortages, and during which time tens, possibly hundreds of thousands of children died. From time to time I run into former Nigerien colleagues, and they always tell me, ‘you must come and visit us again’. Of course, they don’t really mean it. Given my role in emergency response, the only time I visit a country is when it’s in a really, really bad way. Nobody wants that.

The title of this post is, unfortunately, a total misnomer. Niger isn’t in the headlines. It’s barely ever been in the headlines. It got a couple of weeks of coverage in mid-2005, courtesy of a BBC camera crew who visited an MSF feeding centre in the east of the country and snapped some shots of a few skeletal children, thus propelling the story of a famine into the headlines. It also made a blip a couple of months ago when a low-level military coup deplaced Mahmoud Tanja as President of the country, all in the name of a more streamlined democratic process. Maybe 2 days’ worth.

Most people outside France confuse the country with Nigeria, can’t prononce its name, and wouldn’t know the proper noun for its inhabitants (Nigerien, versus Nigerian). I remember doing media interviews with Australian press when I was in the field. Standing on some street corner with a Thuriya Satellite telephone against one ear, the conversations always started the same way: “We’re joined now by an aid worker in Niger. Tell us, where exactly is Niger?”

Niger is facing another food crisis. At this point in time, failed rains have precipitated a state whereby 7.8 million people, more than half the population of the country, are facing food shortages. The government and aid agencies in Niger have all sounded the alert, far earlier than in 2005 (when it wasn’t until mid-year, as the country approached the height of the traditional ‘hardship season’ that the media, and by inference the world, finally started to pay the emergency any attention), and the implications are that 2010 will be a worse year for Niger than 2005 was.

Of course, nobody outside NGO circles is talking about Niger at all.

It Just Ain’t Sexy

There are all sorts of reasons why countries like Niger don’t get press coverage, fitting neatly into the category we in the industry refer to as ‘forgotten emergencies’. That Niger is a geographically obscure former French colony doesn’t help. But beyond that, there’s the dynamic of the emergency itself. Complex.

The media labelled the 2005 crisis as a ‘famine’. The word ‘famine’ makes for a great headline. It has an emotional hit with it. We get images in our head like Ken Carter’s infamous pullitzer-prize winning image of a vulture stalking an emaciated toddler in Sudan. We think of Ethiopia in 1984 and Band Aid; of the Biafra famine and airlift of the late sixties; of the great famines of the Victorian period in India which cost millions and millions of lives.

What happened in Niger, of course, was not a famine. Which was a double-edged sword. On the one hand, no country wants a genuine famine. On the other, it meant that as soon as people started to delve into the root causes of what was happening in Niger, they lost interest. It was too complex to stay on the front pages. Not sexy enough.

It’s the old challenge we’ve faced for years in the aid industry. Natural disasters are fast, shocking and simple to explain. From a media perspective, they are attractive. People eat them up. Disasters like the Haiti earthquake, or the 2004 Boxing Day Tsunami, jolt themselves into the public conciousness and hold headlines- and attention- for weeks. Sympathy- and cash- flows.

By contrast, complex emergencies such as famines, wars, refugee crises and political emergencies are slow-moving, complex, and distinctly lacking in hope. They take far too long to explain to an audience used to the sort of oversaturated ADD-pandering stimulation provided by MTV, Jerry Bruckheimer and Fox News (complete with soundtrack). People lose interest. If they bother to learn even the slightest bit about the crisis, they feel their money will be wasted there. If it’s a war, then anything they give will just get blown up. If it’s a political crisis, then it’ll get eaten by a corrupt system. If a famine, then the children whose lives they save this year will just die in the next hunger season.

There’s more than a grain of truth in this prejudice.

A Beginner’s Guide to Famine

Famine is already a complex proposition. Hunger and starvation are pretty straight forward, but in fact famine is invariably a symphony of contributing elements. It’s food shortages, distribution systems, politics, purchasing power, economics, growing practices, feeding practices, health systems, soil mechanics, climate patterns, and many other things all wrapped up together. Famine deaths are rarely (though occasionally, in acute circumstances) due to actual lack of food, but usually a vicious interplay between nutrient deficiency and disease.

This downward spiral is in itself multipronged and complex- if quite easily explainable if you’re willing to take the time.

We eat food because our body needs certain inputs to maintain healthy life. Energy in the form of sugars, carbohydrates and fats. Building-blocks in the form of proteins. Specific functions supported through the intake of vitamins and minerals- micronutrients. Reduce the intake of any of these things, and the body doesn’t work so well. Reduce them enough over the long-term (chronic malnutrition), and the body doesn’t develop properly- it becomes smaller (stunting) and brain function is reduced. Reduce them enough over the short-term (acute malnutrition), and the body starts to consume itself (wasting), ultimately leading to death if not checked.

In both instances (but particularly situations of acute malnutrition), the lack of essential supplies means that the body is more succeptible to disease. The inbuilt defence mechanisms to fight bacteria and viruses are weaker. At the same time, many diseases also inhibit the correct absorbtion of different nutrients- resulting in a downward spiral, where poor nutrient intake results in disease, which in turn slows nutrient intake. The alternative cycle is equally true where certain diseases (such as malaria, or diarrhoeal diseases) are endemic in a population- disease inhibiting nutrient intake, leading to higher succeptibility to disease.

In both cases, high mortality results. Usually among the most vulnerable members of a population- young children.

There are additional complicating factors. The biggest is hygeine, which contributes to the prevelance and spread of diarrhoeal disease. This in turn is driven both by mechanical factors (is there a sufficient supply of clean water for drinking, washing and cooking?) and behavioural factors (do people wash their hands after going to the toilet and before handling food? Do they boil water?).

A nation’s public health system is the next tier. Is there a network of hospitals, clinics, doctors and nurses to support a population and treat illness? Are there campaigns to reduce endemic and epidemic diseases (such as vaccinations, or mosquito net distributions)? Are there public health messages reaching remote communities to reduce risky behaviour?

Yet another driver that contributes to mortality cycles is population displacement- and particularly, relief camps. Cramming large numbers of people together puts huge stress on food and water production and distribution systems, and existing health care systems. People quickly become under-nourished. Hygeine systems and fecal waste management become difficult. The physical proximity of people to one another vastly accelerate disease transmission rates. The chances of an outbreak of diarrhoeal or viral disease increases by orders of magnitude, and the rapidity with which it can take hold can have catastrophic impacts on existing support networks, and ultimately on mortality.  In the aftermath of the 1994 Rwanda genocide, tens of thousands of ethnic Hutus died in a matter of weeks after diarrhoeal disease ravished displacement camps on the Congolese border.

In short, camps kill.

Malnutrition

The term famine, in the international public health context, relates to a state of excess mortality driven by food shortages- both acute and chronic- across an entire population. In other words, if we call it a famine, we should be expecting to see a rise in the number of people dying in multiple age cohorts, attributable directly to these physiological effects of limited food intake.

In Niger, this was not the case. In fact, during the 2005 hunger season, there wasn’t a single case of a recorded adult death directly attributed to food shortage. The mortality and morbidity was almost exclusively confined to the cohort of children and infants under the age of 5. A nutrition crisis, certainly, but not a famine.

Is this just semantics? Famine, nutrition crisis, surely it’s all pretty much the same thing. People need food, right?

Well, no, actually not right.

Famine, as we’ve already discussed, is a highly emotive word with which we immediately attach baggage. Drought, crop failure, rake-thin Africans and starving babies. People need food, and need it fast. We think famine, we think problem. We think solution, and we think food distribution. Trucks and airplanes loaded with sacks of grain, long queues of colourfully-clad black women with plastic bowls beneath a World Food Program logo. Donors expect it. And, sadly, aid agencies often jump to it as well.

But we’ve already talked about what famine is. It’s so much more complex than this. If we use simple, loaded language to describe the problem, we run the risk of failing to pause and fully understand it. We’ll be easily pressured into jumping into a knee-jerk response. We won’t tackle the problem where it needs to be tackled. And people- children- will die.

Complexities of the Context

Over the last couple of decades, Niger has been consistently ranked at the very bottom of the UNDP’s Human Development Index- somewhere among the poorest three countries in the world, as a rule. This is more than simple economics. It relates, yes, to the fact that the nation produces virtually nothing for the export market except a few crumbly chunks of Yellow-Cake Uranium, but also to the low adult literacy rate, the extremely high birth rate, or the catastrophic infant mortality rate.

Niger exists on the border between Sahel and Sahara- the former being that vast semi-arid band of mixed grass and woodland that stretches from east to west across the African continent and marking the gradual transition from the true-desert of the enormous Sahara to the moist tropical jungles that seethe around the Congo River. The Sahel is characterized by short, intermittent and unpredictable rains, high temperatures, and a current trend towards increasing aridity and desertification. A third of Niger- the southern region- is Sahel. The other two thirds are desert. The vast majority of the country’s population of 15 million live in this southern band, and it is here that the nation attempts to provide enough food to feed itself. 82% of the population are involved in agricultural or livestock production, much of it subsistence. Just 15% of the land area is actually arable.

Niger’s staple is millet, supplemented by sorghum, and small quantities of market vegetables. Millet is a hardy crop which grows well in drought conditions, but which is low in nutrients and hard to digest, particularly by children, and by people who are unwell. It is generally ground into powder and turned into a paste or porridge- something which takes a lot of physical work and energy. Children are typically fed millet from an early age- the traditional weaning age is two, disregarding the health status of the child or the potential benefits of remaining on breast-milk.

Adult males in the family are likely to be fed before children, as they are economically productive and need to be kept healthy to continue bringing resources into the family. Superstitious beliefs in many parts mean that children are not fed eggs (there is a fear that they will grow up to be thieves)- the best and most easily accessible form of protein in most villages. Strong conservative and male-centric values mean that men take the largest and tastiest portions of food, and children and women are fed only after men are satisfied. (There were many reports during our feeding programs of men taking the nutrient paste we had provided to infants and eating it themselves because they liked the sweet taste).

A large portion of the country’s agriculture is subsistence, with any surplus production usually sold on local markets for cash income. Families are large- Niger has a fertility rate of 7.1 children per woman, and it’s common for men to have more than one wife. Water in this arid country is in short supply- 3- 600mm per year, or around a quarter of that of continental Europe. Resource production is spread thin.

In rural areas, all kinds of traditions prevail in child-care. Generations of high infant mortality has resulted in a certain detachment by mothers towards newborn children. In places, mothers will not care for children until they are weaned (when it’s clear that they are not going to die as babies) and the task falls to other women. Colostrum- the thick, nutrient-rich substance that womens’ breasts produce during the first few days following childbirth and which provide newborns with a huge kick-start for life- is considered unclean, and infants are fed water until the mother’s milk becomes ‘normal’. This is a double-whammy, as it means that not only are children denied that boost they need to start life off, but they are often given unclean water, which makes them sick straight off the bat. Assuming they survive (almost 80 in every 1,000 children born in Niger die before they reach the age of 1), they start life off sick, and poorly able to absorb what nutrients come their way, paving the way for high vulnerability to malnutrition.

Roll all of this together, and nearly 170 out of every 1,000 children born in Niger die before they reach the age of five. That’s almost 17%, or more than 1 in 6. Given that the average woman gives birth to 7 children, that means that on average, every woman in Niger will lose at least one child.

In perspective, the infant mortality rate in Australia is 5 per 1,000 live births. The under-5 mortality rate is 6 (in other words, just one out of every 1,000 children born in Australia will die between the ages of one and five, compared to 90 in Niger).

I hope you’re getting the picture.

All this context mumbo-jumbo (that most readers have probably stopped perousing by now) really means that Niger’s population- and specifically, it’s children, are in any given year extremely vulnerable to anything that might reduce their food intake. If, in a normal year, these are the background statistics, and this is the difficulty people have in simply not dying, it means that when the resources available go down, large numbers of people are very rapidly pushed into a place where they will be at risk of death. Which is how, this year, 7.8 million Nigeriens now find themselves at risk of ‘starvation’.

The crisis, as we can see, is not so much an immediate, short-term issue, but rather it’s couched in this long-term situation.

Anatomy of a Crisis

Short-term factors still play a part however, layered into all this complexity. In 2005, the causes were manifold. First off, there were the combination of failed rains across the southern part of the country in the 2004/5 growing season, and a locust invasion which finished off the rest of the crops. So, acute food production shortages.

Merchants with significant purchasing power- many from Nigeria- foresaw that there would be a food shortage, and as soon as the harvests came in, they bought as much as they could from farmers. Many farmers even mortgaged off their coming season’s harvest before it was in- pushing themselves into debt and annihilating their own production and purchasing power to cover short-term needs. Many men left the land and moved to urban areas or out of the country to find waged labour.

As the year progressed and demand for food on the market spiked, it was trickled back onto the market by merchants who were hoarding it- but at hugely increased prices- a simple supply/demand effect. The merchants made a killing. Literally.

This layering of natural and man-made factors pushed a chronically food-insecure context into a critical emergency. Food shortages across the country meant that households simply didn’t have enough to eat. Children- already chronically underfed with low physical tolerance or resistance to nutrient deficiency and disease, bore the brunt of this. They started to waste away by the hundreds of thousands. Many died.

The politics of a male-dominated conservative society compounded things. It was commonplace for men to leave food and seeds locked away in their storehouses. They would take the key with them and forbid the women from touching the food supplies. They would be gone for months at a time without being in contact. We heard of many instances where women refused to take their dying child to a nutrition centre or hospital, because to leave the village they needed their husband’s permission, and he was travelling looking for work.

Into this mix came a government fearful of the implications of an emergency on its population. The last time there had been a major food emergency in the country the government had collapsed as an indirect result. Frightened the same might happen, they became aggressively defensive. Journalists who threw about the word ‘famine’ were kicked out of the country, accused of embarrassing the government which supposedly had everything under control. NGOs had to tiptoe around government sensitivities. Authorities were slow to admit anything was wrong, reluctant to ask for international assistance.

NGOs sent in their emergency teams, loaded with the ‘F’ word and all the professional expectations that carries. Fundraising campaigns were run, small amounts of money raised. We ran food distributions and set up feeding centres. Tens of thousands of metric tons of food aid flowed into the country. Tens of thousands of families received food. Tens of thousands of children were admitted to nutrition programs.

We undoubtedly saved lives.

We undoubtedly failed to prevent some deaths.

Lessons Learned?

Aid reached Niger too little, too late. NGOs rushed in expecting to find an acute famine based on food shortages (failed rains and locusts) but failed to understand the broader context for several months- everything from cultural practices to the ecnomics of supply and demand to a fragile and defensive state structure. While bits and pieces of the long-term situation in Niger certainly began filtering through in the early days, the complexity of setting up a time-critical emergency response and all the operational demands that such a program demands meant that precious little time was dedicated to reflection and understanding. Spurned on by the emotional sense of urgency, key clues were missed.

It took months to re-orient the response to focus on the structural issues. Food distributions- particularly the network of nutrition centres for young children- certainly kept many alive while the process was reshaped. Had the government been more proactive and had the international community (including donors and the international media) pulled their act together in a more timely fashion, that band-aid measure could have prevented far more deaths, and allowed that re-orientation to take place earlier in the journey. As it happened, by the time the context had been analysed and fully understood, donor and media interest had moved on, and there was little additional funding to run essential programs.

But dealing with these big-picture changes is not easy. How does an NGO change the child-care or hygeine practices of a nation? How do they influence government expenditure on health-care networks or vaccination programs? How do they transform the agrarian sector of an entire economy?

The fact is, they can’t. They can tackle the practical issues on a local (village) level. They can advocate to regional and national government officials. But the potential for this big-picture, long-term impact is limited. And sadly, small, short-term changes in a locale which is couched in a much bigger and more complex context tend to be easily undermined.

The Now and the Not Yet

Niger is again on the brink of a food emergency. It remains a severely impoverished country with political upheaval, and a long-standing set of cultural practices, beliefs and dynamics that are unlikely to have changed much over the past 5 years. Programs have been running to tackle chronic malnutrition and food insecurity, but I can’t comment on their efficacy. To the best of my knowledge, millions of children have once again been placed at risk of acute malnutrition, and by all accounts, the lead-in to the current crisis is worse than the lead-in we saw in 2004/5.

Once again, there is no media interest. Once again the year ticks on, and NGOs and the UN have all put out their early-warning reports, and nobody seems to care. Once again, other emergencies overshadow the crisis in Niger- such as the earthquakes in Haiti, Chile and China.

Niger’s hunger season traditionally runs from May to September. That is, the period after the seeds have been planted in the ground and last year’s harvest has been mostly consumed, but before the next harvest is brought in. Every year, rural Nigeriens have to struggle to find a way to keep food on the table- either ration their own dwindling supplies, cut back on the number of meals a day, scrounge for bush fodder, or look for waged labour in urban areas. The longer the hunger period, the harder it is to make these coping mechanisms meet the needs of families. It’s April, and we’ve been seeing signs of food stress for months. The hunger season has already been underway for some time.

If the world intervenes now, lives will be spared. If the media can raise public awareness, and governments and individuals give money and resources to respond to those needs, and NGOs can mobilize response programs early enough, fewer children need to die there this year.

If, as generally happens, we wait to see photographs of emaciated children in feeding centres on BBC and CNN, then lives will have already been lost. The time it takes to ramp up response programs will cost even more lives. This is the practical reality of the aid sector.

The government, at least, appears to be picking up on the mistakes of the past, and is already sounding alarm-bells at its level, accepting that there is a problem. NGOs too have been engaged since early 2006 with the structural issues in-country and are far more aware of the context than they were in 2005. Programs would be run differently. Best practice in the management of child malnutrition has come a long way even over the last 5 years. The UN and interagency partnerships are far better established than they were before, and long-term nutritional programs aimed at structural issues have been running. You can read more about how 2010 differs from 2005 in this analysis by IRIN here. But resource needs remain, without which programs can’t be run.

Sitting as I do in an aid and development charity, knowing full well that we can’t create resources out of thin air, I’m frustrated to know what to do. I have no power over what stories the media runs. I can’t swing government policy. I don’t have the ability to tell the Australian public where to give their [generously donated] funding. All I have is the memory of the faces I saw when I was there five years ago. The barren landscape and the fields dotted with sorry-looking stalks of millet. Skinny children with piano-key ribcages and oversized round skulls. Fierce heat. Looking at the statistics sheets on our feeding centres: The number of new children admitted; the number of those recovered; the number of defaulters; the number of dead.

I’m unlikely to be the guy on the ground this time round. My role doesn’t have me travelling quite so much at the moment, and that’s not likely to change into the near future. I have mixed feelings about this. I don’t particularly want to get embroiled in what is a complex, slow-moving and at times seemingly hopeless context like Niger’s. On the other hand, you don’t get involved with a country in a situation like that without leaving a bit of your soul there, and taking a little of its soul with you.

I sincerely and with all my heart hope that people can get their act together and choose to do something to prevent people dying needlessly in Niger this year.

Photos:

1. Niger River at Sunset: The sun sets over the Niger River as viewed from the Grand Hotel in central Niamey.

2. Feeding Centre Mother and Child: A woman and her malnourished child await registration at an NGO-run feeding centre in central Niger.

3. New Admission: A malnourished infant awaits registration at an NGO-run feeding centre in central Niger.

4. Maria: 2-year old Maria exhibits signs of acute malnutrition. NGO staff talking with her mother try and convince her to take her daughter to hospital.

5. Food Queue: Women queue at an NGO-run food distribution in rural Niger.

6. Warehouse: An NGO warehouse stacked with WFP food aid in rural Niger.

7. Millet Stalks: Staple crop of Niger.

8. La Nutrition: An NGO staff member registers an acutely malnourished child into a feeding program.

9. Recovery: A child who has been in an NGO-run feeding program for some time exhibits signs of improvement.

10: Split Peas and Mais: At an NGO-run food distribution, a man demonstrates the food being distributed.

11: Traditional Coping Mechanisms: An elderly woman sells a plate of baked leaves which she has foraged from the bush as a food source.

12: Hilltop Sunset: The sun goes down over the hills beyond the Niger River near Niamey.